Prepubertal hypertrichosis

Prepubertal hypertrichosis is characterized by an excess of hair growth, seen during birth and progressing during childhood. In generalized hypertrichosis, excessive hair growth occurs all over the body, whereas in localized hypertrichosis, excessive hair growth only occurs in certain areas of the body. As the child grows up, the hair growth may resume, increase, or decrease. However, overall growth patterns and progression may vary based on the classification of hypertrichosis, as well as its association with other disorders. == Causes ==

The precise causes and mechanism of prepubertal hypertrichosis is subject to more intense research, yet it is known that it typically does not result from increased androgen levels, which is a significant characteristic of hirsutism. It is termed "prepubertal" because it occurs before the typical age or onset of puberty and is thus not due to normal hormonal changes that typically occur during puberty. Even though the onset can occur at birth or in childhood, the excessive hair growth can continue onwards into adulthood. Prepubertal hypertrichosis on its own is a relatively rare condition. Reports of prepubertal hypertrichosis can be attributed to a variety of factors such as it being an adverse effect of various medications, or even having an infection, genetic disorder, metabolic disorder, or eating disorders (particularly anorexia nervosa). For instance, leprechaunism has the possibility to be present with hypertrichosis in those born with less fat, though a proper diagnosis would need to be done. The elevated testosterone levels can lead to excessive hair growth all over the body during childhood, with the most affected areas being the face, back, and areas closer to the trunk of the body. Potential mechanisms There is no clear identifiable cause for most cases of prepubertal hypertrichosis. Prepubertal hypertrichosis may be due to genetics, systemic illnesses, or medications. In addition, there are two prominent mechanisms that are currently being used to explain the development of hypertrichosis in individuals. Conversion of hair types The first proposed mechanism states that the excessive hair growth is due to the conversion of vellus hair (peach fuzz) to terminal hair (thick and dark). However the vellus to terminal hair conversion in hypertrichosis has yet to be fully understood. Changes in the hair growth cycle The second proposed mechanism involves the hair follicle growth cycle. Human hair follicles follow a growth cycle that has three stages: anagen, catagen, and telogen. Active growth of the hair follicle occurs during the anagen phase. During the catagen phase, the hair follicle undergoes a process to prepare for hair shedding. The telogen phase is when hair shedding occurs. The hair follicle growth cycle varies by person and by body location of hair growth. Hypertrichosis is said to occur when hair follicles are in the anagen phase longer than normal for their particular hair location. Despite the known mechanisms, there is currently little understanding as to what triggers them. == Diagnosis ==

In order to give the correct diagnosis of hypertrichosis, health care providers must determine if the excess hair growth is truly due to hypertrichosis or if it is due to different conditions such as hirsutism. Hirsutism is defined as excessive hair growth that is limited to androgen dependent areas. On the other hand, hypertrichosis is defined as excessive hair growth anywhere on the body and is independent of androgen. In addition, hypertrichosis is a condition that affects both males and females while hirsutism is primarily used to describe "male-like pattern terminal hair growth in women within androgen-dependent sites". Evaluation Listed below are aspects that physicians take into consideration when determining the classification of hypertrichosis: • Which hair type is predominant • Familial history of hypertrichosis • Any evidence of a genetic syndrome that would cause hypertrichosis • Current medication usage • Thyroid hormone levels • Nutritional status • Cancer == Classification ==

Hypertrichosis diagnosis can be further specified by different classifications. These classifications can be distinguished from one another based on "type of hair, age of onset, distribution of hair, and location of hair growth." After the vaccines were given, the child had developed erythema, swelling, and itch at the two sites, and the hypertrichosis was reported 6 months later. == Psychological impact ==

People with prepubertal hypertrichosis can experience widespread hair growth all throughout the body that can become prominent during childhood. The impact that prepubertal hypertrichosis can have on the individual as well as their family can be difficult, although it is important to note that there are a variety of possible treatment options for these individuals in regards to removing hair. In addition to cosmetic treatments, it is also important to consider psychological care as individuals with the condition may be struggling with their mental health due to their appearance. == Management and treatment ==

Management The degree and type of management depends on the age of the child, the severity and location of the hypertrichosis, and the psychosocial needs of the child, their family, and society. The management strategies for controlling and removing the excessive hair growth include physical management strategies such as shaving, trimming, waxing, and tweezing, chemical strategies such as bleaching or use of chemical depilatories, the use of light sources in laser hair removal, intense pulse light therapy, and electrolysis. While inexpensive, shaving can cause irritation, folliculitis, and ingrown hairs. Chemical depilatories use sulfides, thioglycolates, or enzymatic depilatory agents which dissolve hairs by breaking the disulfide bonds in keratin which normally keep hair strong and healthy. Laser hair removal can cause redness, edema, first to second degree burns, skin damage, and pigmentation. The choice of wavelength depends on a person's skin type and skin condition. IPL is ideal for larger areas and can cause pain, edema, erythema, and pigmentation. While this option is less expensive than laser hair removal, it is also less effective and therefore, requires more treatment sessions. Eflornithine irreversible inhibits ornithine decarboxylase which is an important enzyme involved in hair growth. Elfornithine does not remove hair through epilation or depilation but rather slows hair growths. Some side effects of eflornithine cream include acne, folliculitis, stinging or burning, skin irritation, redness, itching, and dizziness. Eflornithine cream is not meant to be used alone and is recommended to be combined with another hair removal technique. The FDA only approved elfornithine cream for use on the face and other adjacent areas under the chin, and not the entire body. Drug discontinuation If the cause of hypertrichosis was due to a particular medication, the discontinuation of said medication usually reverses the effects of excessive hair growth. == See also ==